Epidemiologic and clinical characteristics of acute diarrhea with emphasis on Entamoeba histolytica infections in preschool children in an urban slum of Dhaka, Bangladesh

Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 10/2003; 69(4):398-405.
Source: PubMed


The epidemiology, clinical features, nutritional status, and causative agents of diarrhea were studied in 289 Bangladeshi children (147 boys and 142 girls) 2-5 years old. The use of improved diagnostic tests for amebiasis enabled for the first time analysis of the contribution of Entamoeba histolytica to total diarrheal illness in this community setting. The average incidence rate of diarrhea was 1.8/child-year, and the average number of diarrheal days was 3.7 days/child-year over an average observation period of 2.8 years/child. Seventy-five percent of the diarrheal episodes were < or = 2 days in duration. Persistent diarrhea was relatively uncommon (0.2% of the children) and chronic diarrhea was observed in only one episode. Compared with malnourished and/or stunted children, better-nourished children experienced significantly fewer diarrheal episodes. The diarrheal incidence rate for children with blood group A was significantly less that that of the children with blood groups O and AB. The most frequent bacterial enteropathogens isolated from diarrheal stool specimens were enterotoxigenic Escherichia coli (9%) and Aeromonas species (9%), followed by Plesimonas shigelloides (4%) and Shigella flexneri (3.8%). Rotavirus was the most common viral agent isolated from diarrheal stool samples (5%). Giardia lamblia, Cryptosporidium parvum, and E. histolytica were identified in 11%, 8.4%, and 8%, respectively, of the diarrheal stool specimens. Dysentery was observed in 7.7% of all diarrheal episodes. The most common pathogens isolated from dysenteric stool were S. flexneri (11.6%), Aeromonas sp. (10%), E. histolytica (8.7%), Campylobacter jejunii (5.8%), P. shigelloides (4.3%), and A. caviae (4.3%). The overall incidence rate of E. histolytica-associated diarrhea was 0.08/child-year. Visible blood and hemoccult test-detected blood loss was found in 7% and 25%, respectively, of cases of E. histolytica-associated diarrhea. Children who had recovered from a diarrheal episode with E. histolytica, but not E. dispar, had half the chance of developing subsequent E. histolytica-associated diarrhea, consistent with the development of species-specific acquired immunity. In conclusion, the use of modern diagnostic tests demonstrated that E. histolytica contributed to overall morbidity from diarrheal illness. Understanding the etiology, frequency, and consequences of acute diarrhea in children from a developing country should aid in the design of interventions to improve child health.

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Available from: Rashidul Haque, Mar 19, 2014
    • "Zaman et al. (2009) reported similar peaks of rotavirus diarrhoea during the monsoon period as well as during the cold and dry winter time. In the urban slum community of Mirpur in Dhaka, Entamoeba histolytica was the most prevalent enteropathogen among pre-school children and was the highest during the warm months of the year, from March to August (Haque et al., 2003). The highest mortality from diarrhoea was also reported in warmer and more humid regions (Becker and Weng, 1998; Singh et al., 2001). "
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    ABSTRACT: Diarrhoeal diseases constitute an important public health problem in many developing countries including Bangladesh. This study aimed to report the household-level determinants of diarrhoea using the baseline information of cohort studies conducted in 2008 and 2009. The variation of diarrhoea by 3-month period was also reported. A total of 3,207 households were systematically selected from 12 slums in Dhaka and three rural villages located nearby. The highest prevalence of diarrhoea was found during the period of September to November (22.7%) and the lowest during December to February (9.2%). Slum households were more affected by diarrhoea as compared with the rural households (OR = 1.49; 95% CI = 1.06–2.08; p = 0.020). Other determinants namely provisional house, sharing water source, and sanitary, and use of surface water were also associated with a higher risk of diarrhoea. In conclusion, slum households suffered more from diarrhoea than rural populations. Moreover, the higher burden of diarrhoea were found to be strongly and persistently associated with adverse housing and environmental conditions. Public health strategies based on our findings are required to reduce the burden of diarrhoea in the study population. Particularly multilevel interdisciplinary actions are needed to improving the quality of housing, water, and sanitation facilities in urban slums of Dhaka, and similar settings elsewhere. Copyright © 2013 John Wiley & Sons, Ltd.
    No preview · Article · Aug 2014 · Population Space and Place
    • "Amebiasis caused by the intestinal parasite Entameba histolytica, is a disease of global health importance, especially in developing countries.[12] It has an estimated worldwide prevalence of 50 million cases of symptomatic disease and is responsible for 40000-110000 deaths annually. "
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    ABSTRACT: Intestinal amebiasis is an important public health problem worldwide. More severe disease is associated with young age, malnutrition and immunosuppression. The aim of this study is to evaluate the prevalence and characteristic nature of intestinal amebiasis among pediatric population, and compare it with other causes of gastroenteritis. This is a retrospective comparative study conducted at Makassed General Hospital between January 2008 and December 2012, including all pediatric patients between birth and 15 years of age, who presented with symptoms of acute gastroenteritis. One thousand three hundred ninety-five patients were included in the study, and were divided into four groups: Group I (Entameba histolytica group = 311 cases, 22.3%), group II (Rotavirus group = 427 cases, 30.6%), group III (bacterial group = 107 cases, 7.7%), group IV (unidentified group = 550 cases, 39.4%). Significant leukocytosis, neutrophilia and positive C-reactive protein were found among more than 50% of admitted Entemaba histolytica cases with a picture of severe invasive disease in young infants. Entameba histolytica can be an emerging serious infection, especially when it finds suitable environmental conditions and host factors, so we should be ready to face it with effective preventive measures.
    No preview · Article · Dec 2013 · North American Journal of Medical Sciences
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    • "The methods for sample collection and analysis closely followed previously described methods.18 To measure intestinal parasites, fieldworkers collected one stool specimen from each target child and additional stool samples from a convenience sample of 69 siblings (< 1 month to 20 years) of the target children. "
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    ABSTRACT: We assessed the relationship of fecal environmental contamination and environmental enteropathy. We compared markers of environmental enteropathy, parasite burden, and growth in 119 Bangladeshi children (≤ 48 months of age) across rural Bangladesh living in different levels of household environmental cleanliness defined by objective indicators of water quality and sanitary and hand-washing infrastructure. Adjusted for potential confounding characteristics, children from clean households had 0.54 SDs (95% confidence interval [CI] = 0.06, 1.01) higher height-for-age z scores (HAZs), 0.32 SDs (95% CI = -0.72, 0.08) lower lactulose:mannitol (L:M) ratios in urine, and 0.23 SDs (95% CI = -0.63, 0.17) lower immunoglobulin G endotoxin core antibody (IgG EndoCAb) titers than children from contaminated households. After adjusting for age and sex, a 1-unit increase in the ln L:M was associated with a 0.36 SDs decrease in HAZ (95% CI = -0.64, -0.07). These results are consistent with the hypothesis that environmental contamination causes growth faltering mediated through environmental enteropathy.
    Full-text · Article · Apr 2013 · The American journal of tropical medicine and hygiene
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